Recent reform initiatives in Puerto Rican health care financing and delivery may have significant impacts in cancer treatment and outcomes. The overall goal of this research is to assess whether these impacts have been favorable in general, and cost-effective in particular. The principal aim of this pilot project is to assemble and analyze data on two subgroups of breast cancer cases in order to test the feasibility of conducting empirical research in this setting and, if feasible, to adduce preliminary evidence on the impacts on health care reform in the oncology arena. The study population will encompass medically indigent women diagnosed and treated for breast cancer prior to the enactment of the reform legislation in the public sector delivery system and those diagnosed and treated after the reforms will the new private sector managed care system. The analysis will focus on differences between the two groups in the stage distribution at diagnosis as well as other outcomes such as survival, disease recurrence, and compliance with follow-up regimens. Differences attributable to health care reform will also be gauged by changes in the patterns and cost of treatment received by women diagnosed at the same stage. The pilot study will appraise whether needed data can be obtained from the Tumor Registry, chart abstraction, and insurance reimbursement records. If feasible, the study design will be refined for a larger proposal for funding that would, among other things, expand the size and nature of the study population as well as the set of specific hypotheses relating to the delivery of cancer care to minority populations that can be tested with those data. Relationship of this Project to the Overall Objectives of the Collaboration Timely access to effective cancer therapy depends crucially on the way health care is delivered and financed. A systematic program of empirical research on cancer outcomes and the associated patterns of treatment use and costs can provide evaluative criteria for identifying policy changes that improve the prospects of cancer patients. Thus, the goals of this project are highly consistent with the overall goals of the partnership between HLMCC and PRCC, especially developing research interactions that lead to new knowledge about minority health concerns.